ONC: Breast Cancer: Radiation and Use of Antioxidant Vitamin E Oral Supplement 2007
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
ONC: Breast cancer: Vitamin E and Radiation
If vitamin E (alpha tocopherol, 670-1000 mg) oral supplement is proposed to promote tolerance or reduce late-effects of radiation, advise that no research is available on the impact of vitamin E supplementation to promote tolerance of radiation. Evidence is inconclusive on the benefit of vitamin E for treatment of chronic radiation-induced fibrosis. Vitamin E supplementation may have adverse effects such as nutrient-nutrient interactions, drug-nutrient interactions (e.g., anti-coagulant and anti-hypertensive medications/herbal supplements) and disease-related complications.
Risks/Harms of Implementing This Recommendation
No potential risks or harms are associated with implementation of this recommendation.
Conditions of Application
No conditions limit the application of this recommendation.
Potential Costs Associated with Application
No obvious costs are associated with the application of this recommendation.
- One positive quality RCT (Gothard et al, 2004) found no benefit with the combination of an oral supplement vitamin E (1000 mg alpha-tocopherol a day) in combination with 800 mg per day of pentoxifylline on the treatment of chronic RIF resulting from breast cancer treatment.
- A neutral quality observational, single group before-after time series study (Delanian et al, 2005) found significant regression of chronic RIF at 6 months and maximum fibrosis regression at 36 months after treatment with 1000 IU of alpha-tocopherol per day. All RIF areas responded well to treatment, and symptom severity diminished by half as assessed by the SOMA score. However it is important to note that this study used an unvalidated method to measure fibrosis and a convenience sample.
- Studies measured change in fibrosis using vastly different methodologies--surface measures of palpable fibrosis verses optical measures using a perometer. Additional work is needed to develop and validate operator-independent measures of radiation effect.
- Further research is needed.
Recommendation Strength Rationale
- Based on one positive quality RCT and one neutral quality observational, single group before-after time series study, conclusion statement is a Grade III.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Is there a relationship between supplementation of antioxidant vitamin E, which may interact with radiation therapy treatment, tolerance of radiation therapy treatment and late-effects of radiation therapy treatment in patients with chronic radiation-induced fibrosis resulting from breast cancer treatment?
Delanian S, Porcher R, Rudant J, Lefaix J-L. Kinetics of response to long-term treatment combining pentoxifyllin and tocoperol in patients with superficial radiation-induced fibrosis. Journal of Clinical Oncology 2005; 23:8570-8579.
Gothard L, Cornes P, Earl J, Hall E, MacLaren J, Mortimer P, Peacock J, Peckitt C, Woods M, Yarnold J. Double-blind placebo-controlled randomized trial of vitamin E and pentoxifylline in patients with chronic arm lymphoedema and fibrosis after surgery and radiotherapy for breast cancer. Radiotherapy and Oncology 2004, 73: 133-139.